On Monday, as Gov. Mike Dunleavy announced cuts to the state budget, including $50 million for Medicaid, Planned Parenthood affiliates nationwide decided to withdrawal from the Title X federal funding program.

That decision will make access to health care in Alaska more difficult, according to Jessica Cler, Alaska Director of Planned Parenthood Votes Northwest and Hawaii, the advocacy arm of Planned Parenthood in Alaska.

“This withdrawal (of federal funding) hits Alaska the hardest,” Cler said in a phone interview Tuesday. “We already know that access to health care is a challenge here, from provider shortages to the high cost. So with the gag rule on top of the drastic budget cuts from the governor … health care is going to be increasingly hard to access and will particularly hurt low-income folks the hardest.”

Planned Parenthood withdrew from the program because of a new rule, known as the gag rule, imposed by the Trump administration that prevents recipients of Title X federal funding from informing their patients of how or where they can access abortion.

“We believe it is unethical to not give the most accurate information to our patients,” Cler told the Empire. “That includes telling them how to access abortion.” The new rule allows for clinics to tell patients that abortion is an option, but does not allow direct referrals to other health centers.

According to Cler, Planned Parenthood in Alaska provides services to 74 percent of the patients served by Title X in Alaska, which is more than 6,000 people. A statement from Planned Parenthood of the Greater Northwest and Hawaiian Islands (PPGNHI) said that roughly 25 percent of those patients are uninsured, meaning their access to health care is already limited.

In addition to the gag rule, the Trump administration has imposed other rules for Title X recipients, which Planned Parenthood considers to be cost prohibitive and unnecessary.

In “a move that is clearly targeted at Planned Parenthood,” according to Cler, the Trump administration has imposed physical separation requirements for health centers which provide abortion. According to a statement from Planned Parenthood released in February, physical separation requirements could force health clinics which provide abortions to construct new entrances and exits or entirely new clinics. The administration’s rule also imposes financial separation meaning that clinics wanting to provide abortion would have to hire a separate staff of doctors, nurses and administrative staff.

Title X does not provide money for abortions, only birth control and reproductive health care. Physical separation rules would mean that a clinic which provides abortions could not also provide things like birth-control pills or sexually-transmitted infection screening or treatment at the same location or by the same staff.

Cler said that Planned Parenthood in Alaska was not yet able to determine just how the governor’s cuts would impact the organization’s services.

“We’re going to continue to do everything we can to offer the same care to our patients but we know that’s not sustainable,” Cler said. “We’re looking at other options over the next couple of months.”